Network Adequacy Waiver Request - Major Medical

This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on physicians, providers, and facilities, other than facility-based physicians and providers. Related datasets are available for major medical (facility-based providers) and vision plans:

 •  <strong>Facility-based Physicians & Providers:</strong> <a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Facility-based-Phy/e597-cvix/about_data"  target="_blank"><u>Network Adequacy Waiver Request - Facility based Physicians & Providers</u></a>.This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on facility-based physicians and providers.

 •  <strong>Vision: </strong><a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Vision/2zru-e4u3/about_data"  target="_blank"><u>Network Adequacy Waiver Request - Vision</u></a>. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.

Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.

Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.

Data and Resources

Field Value
accessLevel public
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catalog_@id https://data.austintexas.gov/data.json
catalog_conformsTo https://project-open-data.cio.gov/v1.1/schema
catalog_describedBy https://project-open-data.cio.gov/v1.1/schema/catalog.json
identifier https://data.austintexas.gov/api/views/yfeb-xw4b
issued 2025-05-02
landingPage https://data.austintexas.gov/d/yfeb-xw4b
modified 2025-08-05
publisher data.austintexas.gov
resource-type Dataset
source_datajson_identifier true
source_hash fe4714a86b1cef06c65c91e2c269c599e5d2b0960ac5dfc8acb9eaf1b80a27d0
source_schema_version 1.1
Groups
  • AmeriGEOSS
  • National Provider
  • North America
Tags
  • AmeriGEO
  • AmeriGEOSS
  • CKAN
  • GEO
  • GEOSS
  • National
  • North America
  • United States
  • access-plan
  • county
  • date
  • health
  • hearing
  • insurance
  • network
  • network-adequacy
  • ophthalmologist
  • optometrist
  • provider
  • serff
  • specialty
  • status
  • tdi
  • waiver
isopen False
license_id notspecified
license_title License not specified
maintainer TDI ODP Administrator
maintainer_email no-reply@data.texas.gov
metadata_created 2025-09-24T15:09:50.631956
metadata_modified 2025-09-24T15:09:50.631963
notes This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on physicians, providers, and facilities, other than facility-based physicians and providers. Related datasets are available for major medical (facility-based providers) and vision plans: • <strong>Facility-based Physicians & Providers:</strong> <a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Facility-based-Phy/e597-cvix/about_data" target="_blank"><u>Network Adequacy Waiver Request - Facility based Physicians & Providers</u></a>.This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on facility-based physicians and providers. • <strong>Vision: </strong><a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Vision/2zru-e4u3/about_data" target="_blank"><u>Network Adequacy Waiver Request - Vision</u></a>. This dataset relates to waiver requests for networks used for vision PPO and EPO plans. Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information. Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: <a href="https://www.tdi.texas.gov/hmo/mcqa/network-adequacy-standards-waivers.html" target="_blank"><u>Network Adequacy Standards Waivers</u></a>.
num_resources 4
num_tags 24
title Network Adequacy Waiver Request - Major Medical